目的:报告一系列恶性青光眼(MG)患者长期治疗成功的影响因素。
方法:回顾性,介入,连续病例系列受试者:这项研究使用了斯坦因眼科研究所青光眼部门从1997年到2022年收集的数据,加州大学,洛杉矶(UCLA)。纳入所有在UCLA接受治疗的MG患者。
方法:收集并分析了以下人口统计学和临床数据与成功治疗的相关性:年龄,性别,种族,青光眼家族史,视敏度(VA),眼内压(IOP),镜头状态,先前的青光眼诊断,先前的眼科手术,之前使用抗青光眼剂,超声波轴向长度,定性前房(AC)深度,治疗方法和结果。
方法:解剖成功定义为恢复正常的AC深度,表明MG发作缓解。完全成功定义为解剖学上的成功和IOP降低至<21mmHg而无需进一步手术。有或没有药物。
结果:73例患者的74只眼被诊断为MG。MG就诊时患者的中位年龄(四分位距)为70岁(19.5),49例(75.4%)患者为女性。MG之前最常见的先前诊断是原发性闭角型青光眼(PACG)(34眼,51.5%)。30眼(45.5%)的起始事件为青光眼手术,21眼(31.8%)的起始事件为白内障手术。大多数眼睛是假晶状体(57,86.4%)。56只眼接受了药物治疗;仅通过药物治疗,MG就有2只眼解决。9只眼(7只眼=治疗幼稚;2只眼=药物治疗失败)接受激光治疗,5只眼MG消退。在接受手术治疗的55只眼中,52只眼治疗失败,3只眼治疗幼稚。手术治疗的解剖成功率为96.4%,最常用的手术方法是联合平面前中央玻璃体切除术。透明带束切除术和虹膜切除术。
结论:女性性别,PACG,青光眼手术是MG发生的诱发因素。在绝大多数情况下,仅对MG进行药物治疗是不够的。一种由平面前中央玻璃体切除术组成的联合手术技术,透明带束切除术和虹膜切除术始终取得了很高的长期成功。
OBJECTIVE: To report the contributing factors to the successful long-term treatment outcomes of a large series of patients with malignant glaucoma (MG).
METHODS: Retrospective, interventional, consecutive case series.
METHODS: This study used data collected from 1997 to 2022 from the Glaucoma Division of the Stein Eye Institute, University of California, Los Angeles (UCLA). All patients with MG who underwent treatment at UCLA were enrolled.
METHODS: The following demographic and clinical data were collected and analyzed for their relevance to successful treatment: age, gender, ethnicity, glaucoma family history, visual acuity (VA), intraocular pressure (IOP), lens status, prior glaucoma diagnosis, prior ocular surgery, prior use of antiglaucoma agents, ultrasonic axial length, qualitative anterior chamber (AC) depth, and treatment methods and outcomes.
METHODS: Anatomical success was defined as restoration of normal AC depth, indicating relief of the MG episode. Complete success was defined as anatomical success and the reduction of IOP to < 21 mmHg without further surgery, with or without medications.
RESULTS: A total of 74 eyes of 73 patients were identified with a diagnosis of MG. The median (interquartile range) age of the patients at the time of MG presentation was 70 years (19.5) and 49 (75.4%) patients were female. The most common prior diagnosis before MG was primary angle closure glaucoma (PACG) (34 eyes, 51.5%). The initiating event for 30 eyes (45.5%) was glaucoma surgery and for 21 eyes (31.8%) was cataract surgery. Most eyes were pseudophakic (57, 86.4%). Fifty-six eyes underwent medical treatment; MG resolved in 2 eyes with medical treatment alone. Nine eyes (7 eyes = treatment naïve; 2 eyes = failed medical treatment) underwent laser treatment and MG resolved in 5 eyes. Among the 55 eyes which had surgical treatment, 52 eyes failed medical treatment and 3 eyes were treatment naïve. The anatomical success rate with surgical treatment was 96.4% and the most commonly performed surgical procedure was combined pars plana antero-central vitrectomy, hyaloido-zonulectomy, and iridectomy.
CONCLUSIONS: Female gender, PACG, and glaucoma surgery were predisposing factors for the development of MG. Medical treatment alone for MG was inadequate in the vast majority of cases. A surgical technique consisting of combined pars plana antero-central vitrectomy, hyaloido-zonulectomy and iridectomy consistently produced high long-term success.
BACKGROUND: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.